Accident Detail Receipt
Date And Time 08-May-2018 / 2:30 pm
Place of Accident Shirpur Thalner Road Aadhe Goan Near
CR NO/ TAR No/ SDE NO 25-2018
Name of the Injured/ Deceased Injured Name Sunil Popat Patil At Post Aadhe Tal Shirpur Dist Dhule
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur Dist Dhule
Number of vehicle and type of the vehicle 1) Mahindra Company Car No MH 18 AJ 5200 2) Motar Cycle No MH 18 AR 4865
Name of address of driver of the vehicle with perticuler ordriving license of the said driver and the address of the issuing Authority of the said driver license. The number of badge in case of public service vehicle and the address of the issuing Authority of the said badge. --
Name of the owner of the vehicle as it stand on the date of the accident --
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. --
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate --
Action Taken if any, and the result thereof. --

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